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Peter J. Koltai MD is Professor of Otolaryngology and Pediatrics in the in the Department of Otolaryngology Head and Neck Surgery. He has been a member of the Stanford University School of Medicine faculty since 2004.Born in Hungary and educated in the New York City schools, Peter graduated Albany Medical College in 1975, completed his otolaryngology residency at the University of Texas Medical Branch (1980) and did a fellowship in Pediatric Otolaryngology in London’s Great Ormond Street Hospital for Sick Children (1989). Before coming to Stanford, Peter was Professor of Surgery and Pediatrics in the Division of Otolaryngology at Albany Medical College and then Head of the Section of Pediatric Otolaryngology at the Cleveland Clinic. He served as Division Chief of Pediatric Otolaryngology at LPCH from 2004 – 2013. He served as Medical Staff President of Lucile Packard Children’s hospital from 2012 – 2014. Peter has held multiple leadership positions in organizations within the scope of his interest and is past President of the American Broncho-Esophagological Association and of the American Society of Pediatric Otolaryngology, Author of several books, many chapters, and over a hundred publications, many self-illustrated, Peter’s academic and clinical interests have focused primarily on creative solutions to difficult surgical problems. These have included establishing new techniques for the management of pediatric facial fractures, a novel method of tracheostomy, refinements in laryngotracheal reconstruction and approaches to choanal atresia, the development of microdebrider shaver blades for “powered” adenoidectomy and “partial” tonsillectomy, and the design of high pressure balloons for airway dilation. Peter’s current focus is secondary sleep apnea surgery in children having pioneered pediatric sleep endoscopy and developed endoscopic techniques of pediatric tongue base surgery. Peter has several current advocacy interests. One is the multi-organizational Task Force that he established as ABEA president and which is devoted to the prevention of button battery ingestion by young children. Peter recently became a Senior Fellow in Stanford’s Center for Innovation in Global Health and has been working with colleagues at the University of Zimbabwe in Harare, establishing a Pediatric Otolaryngology clinic at the Harare Children’s Hospital.
clinical pediatric otolaryngology
University of Zimbabwe
Children of Zimbabwe
Maximizing the safety and efficiency of swallowing in children with disabilities
Center for the Disabled, Albany NY
Children with neurodevelopmental delay
Curating and exhibiting contemporary art of the Hudson - Mohawk region of New York State
Albany Center Gallery
Population of Upstate New York
It has been well-recognized that tonsillectomy and adenoidectomy is the primary treatment for pediatric obstructive sleep disordered breathing. However, it is also recognized that approximately 15-20% of the children will continue to have problems with obstructive sleep disordered breathing, despite having their tonsils and adenoids out. The primary problem of sleep apnea in children who have had their tonsils and adenoids out was identifying the site of obstruction. Since fiberoptic laryngoscopy is a routine part of our office exam in our evaluation of children with sleep apnea, it seemed like a natural evolutionary step to perform a similar type of examination while the children are under anesthesia. Clearly an anesthetic induced sleep is not real sleep; on the other hand, it is about the closest model to real sleep that we have. Based on this insight, we began to offer sleep endoscopy to the parents of children who we were seeing who had failed tonsillectomy and adenoidectomy and had persistent sleep apnea. What we found out during sleep endoscopy was that there can be multiple levels of obstruction. However, the two most consistent sites of obstruction were due to enlarged lingual tonsils, where the lingual tonsils caused a prolapse of the epiglottis up against the posterior pharyngeal wall during recumbent sleep and from an occult form of laryngomalacia, where the soft tissues of the posterior glottis prolapsed into the laryngeal introitus on inspiratory effort during sleep. Lingual tonsillar hypertrophy is recognized as a cause of obstructive sleep apnea in children, however, the form that was typically seen prior to our current work was in children who had grossly enlarged lingual tonsils, easily seen on an office exam. What we were seeing on our sleep endoscopies was a more subtle form of lingual tonsillar hypertrophy which was obvious only on the sleep endoscopy but was not readily discernible on fiberoptic laryngoscopy in the office. Similarly, while laryngomalacia is an airway problem that is well recognized in new born infants, it has not been previously demonstrated to be a cause of sleep apnea in older children, especially without any daytime manifestation of the obstruction. We now have many video recordings demonstrating the phenomenon in older children. Our experience with infant laryngomalacia provided a means of treating this form of obstruction.We also observed other types of obstruction on sleep endoscopy not related to lingual tonsillar hypertrophy or to occult laryngomalacia,. These obstructions were from hypotonia, due to excessive relaxation of the pharyngeal musculature during sleep, obesity with a marked narrowing of the entire oropharyngeal space probably as a consequence of fatty deposition in the surrounding musculature.